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ORIGINAL: Englislt
COUNTRY /I.{OTF: I{IGERIA Proiect Namet Osun Stote CDTI
Approval year: 1998 Launching year: 1998
Rerrortinq Period (Month/Year): October 2002 - September 2003
Date submitted: DECEMBER 2003 NGDO partner: UNICEF
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I YEAR 5 ANNUAL PROJECT TECHNICAL REPORT I
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I \ TO .!- Ey TECHNICAL CONSULTATIVE CONTuTITTEE (TCC)
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I AFRICAN PROGRAMME FOR ONCHOCERCIASTS CONTROL (APOC) i w ,.*dh
WFIO/APOC. 2(r Scptember' 2003 ANNTIAL PROJECT TECHNICAL REPORT TO TECHNICAL CON SULTATIVE COMMITTEE (TCC) ENDORSEMENT
Please confirm you have read this report by signing in the appropriate space.
OFFICERS to sign the report:
country : NIGERIA/LIBERIA
National Coordinator Name: Dr. J. Y. tiya.
,atl Signature i.i" ': Date .:...... i". . . . k:-...,'.i*l
Zonal Oncho Coordinator Name: Mn A. O. Jaiyeoba
Signature
Date
This report has been prepared by Name . Mr. Matthew Lelaboye
Designati on : State Coordinutor
2n$?1- Table of contents
...... IV
DEFINITIONS ...... V
FOLLOW UP ON TCC RECOMMENDATIONS 1
EXECUTIVB SUMMARY 2
SECTION 1: BACKGROUND INFORMATION 3
1.1 . GsNuRal- INFoRMAlloN ...... J 1.2. PopuLettoN aNo HenlrH SYSTEM 6 SECTION 2: IMPLEMENTATION OF CDTI 8 2.1. PnnloooF'4CTIVITIES ...... 8 2.2. OIrotRtNc. sroRAGE AND DELIVERY ol'- IVEI{MECl'lN 10 2.3. AovocacY aNP SsNsl'rIZAl'loN l1 2.5. COUUUNITIES INVOLVEMENT IN DECISION-MAKING . 14 2.6. Cnpacttv BUILDING I6 2.6.1. Training..... l6 2.6.2. Equipnrcnt and human re,\otrces... 1B * CoNotroN oF TFIE EQUIPMENT PLSRSp srATE 18 2.7. TRcRrutuNrs...... 20 2.7.1. TreutmentJigures...... 20 'r't OROLU 2.7.3. Trend oJ'treotment ctchiet,ement from CDTI project inceplion to the currenl yeor25 * 3 LGAS (INE SOU'rrI, IIE NONT-U & EOP SOUTU) WE,RE I-ATER FOT-]ND TO BI] HYPO DNDI]MIC AND EXCLUDED FRoM MASS r)rsl'R.tBr.JTroN op MscttzaN IN ENDEMIC coMMt;Ntrtss...... 25 2.8. SupsnvlsloN...... 26 SECTION 3: SUPPORT TO CDTI.... 28 3.1. FINnNCtel CONTRIBUI'IONS OF' THE PARTNLIRS AND COMMUNITlllS...... 28 3.2. OrNNN I-ORMS OF COMMUNITY SUPPOR-I ...... 28 3.3. Expt-NottunEPE,RAcl'lvlrY...... 2e SECTION 4: SUSTAINABILITY OF CDTI ...... 30 4.1. INrpnNal-; INDDPENDENT PAR'IICIPATORY MONI'IORING; Evat.UnrlON...... 30 RpcovnauNDnl'toNs nr LGA L9v11...... 3 I REcovul,NDATIoNS a'l' FLHF LEvEI- ...... 33 REcovUnNDATIoNS Rr CouvuNITY LEVEL ...... 34 4.2. CoulauNtrY sEl.F-MoNIToRING aNn Strrrsllol.DE,l{s Mee'rtNc ...... 35 SusTRINnBILITY oF PROJEC.IS: PLAN AND SET TARGETS (MAND^TORY YR 3)...... 36 4.3. ^,I 4.4. INtrclrR'rtoN ...... 38 4.5 Opnne ttoNAt. RESEARCI I ...... 39 SECTION 5: STRENGTHS, WEAKNBSSES AND CHALLENGES ...... 40
lll WHO/APOC', 26 Septernber' 2003 Acronyms
APOC African Progratnme for Onchocerciasis Control ATO Annual Treatment Obj ective AtrO Annual Training Objective CBO Community-Based Organization CDD Comrn unity-Directed Distri butor CDTI Community-Directed Treatlnent with Ivermectin CSM Comrn unity Self-Monitoring FLHF First Line Health Facility FMOH Federal Ministry of Health GCCC Government Cash Counterpart Contribtrtion IFESH International Foundation fbr Education and Self Help LGA Local Government Area LOCT Local Government Onchocerciasis Control Team MOH Ministry of Health NGDO Non-Governmental Development Organization NGO Non-Governmental Organization NID National Ittrmunization DaY NOCP National Onchocerciasis Control Programme NOTF National Onchocerciasis Task Force NPI National Programme on Immunization PHC Prirnary health care RE,MO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting SMOH State Ministry of Health SOCT State Onchocerciasis Control Tearn TCC 'fechnical Consultative Comtnittee (APOC scientiflc advisory group) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization
tv WI IO/APOC. 26 Septcmber' 2003 Definitions
(i) Total ation: the total population living in rneso/hyper-endemic commuttities within the project area (based on REMO and census taking)
(ii) Eligible population: calculated as 84oh of the total population in rneso/hyper- endetnic comtnunities in the project area.
(iii) Annual Treatrnent Objective: (ATO): the estimated number of persons living in ineso/hyper-endemic areas that a CDTI project intends to treat with iverrnectin in a given year.
(iv) Ultimate Treatment Goal (UTG): calculated as the maxitnum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (norrnallythe project should be expected to reach the UTG at the end of the 3'o year ofthe project).
(v) Therapeutic coverage: nutnber of people treated in a given year over the total population (this should be expressed as a percentage).
(vi) Geographical coverage: number of communities treated in a given year over the total-number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage).
WFIO/APOC. 26 Septernber 2003 FOLLOW UP ON TGG REGOMMENDATIONS
Using the table below. fill in the recommendations of the last TCC on the project and describe how they have been addressed.
TCC session
Number of TCC ACTIONS TAKEN FOR TCC/APOC MGT Recomntendoliott RECOMMENDATIONS BY THE PROJECT USE Ol'lLY in tlte Reporl
(Plea,se atld tttore rotus if necessary)
WI IO/APOC. 26 September' 2003 Executive Summary
Osun State is one of the states in the South Western part of Nigeria and is located in the B HealthZone.It is a predominantly Yoruba State. Other ethnic groups like Hause, Ibo, Fulanis and Agatus horvever reside in all parts of the State.The State has a population of about 2.2rnillion (1991 census). However. 760,988 is estirnated to be living in 1,131 communities
in the 14 endemic LGAs in the state. Population movetnents occttr due to the following reasons:
population displacements
/ The movernent of the Agatus into the State during the farming season, and return to their ancestral places thereafter. Of the total population of 760,988, 531,361 people were treated during the period with
1,300,568 tablets. This represented a 70o/otherapeutic coverage.
Targeted trainings were conducted in the 5th year of the project. Only 678 CDDs and 543 Health workers were trained/retrained. These represented an achievetnent of 97%o and 95oh
respectively as far as AtrOs are concerned.
Strengths of the project include existence of Sustainability plans based on realistic budgeting rvhich can be bLrilt on for an effective and efficient progratnme implementation. increasing support by LGAs for CDTI irnplernntation, integration of CDTI activities into other PHC activities, particularly at the LGA level, and appointrnent of sorne CDDs as top political functionaries in some assisted LGAs in the State. Greater slrpport is therefore anticipated from
such LGAs, if they continue in office.
The rnajor challenges that faced the project are the strike action by the entire r,vork lorce in Osun State for a period of 3 months which disrupted implernentation of planned activities. lirnited involvement of Health Centre/Post staff in CDTI activities, inadequate Irotivation of CDDs by the cornrnunities and lack of adequate census update. To address these challenges the project tried to carry out activities on a limited scale during the strike period; efforts were rnade to train more health facility staff and communities have been re - rnobilized to contribute rnore to the CDTI process especially with regards to incentives to CDDs. A censtts
update with assistance fiom UNICEF is being planned lbr February 2004.
2 WIIO/APOC, 26 Scptember 2003 SECTION {: Background information
1.1. General information
1.1.1 Description of the project(briefl y)
Geographical locatiott, topography, clinnte Osun State is one of the states in the South Western part of Nigeria and is located in B Health Zone. lt is boLrnded by Kwara State to the North, Ekiti and Ondo States to the East, Ogun
State to the South and Oyo State to the West. The State has a land mass of about 8,572 sqLrare kilometers. The State has two distinct seasons, dry season and rainy season. The rainy season begins in March and is heaviest from June through September/October. Farming generally begins in April, most farm work is completed by October, after which the harvesting is carried out. The dry season begins in November and ends in mid-March.
Population: uctivities, culture, longuage Osun State has a population of about2.2million (1991 census). Yorubas constitute the major ethnic group, although some minorities such as the Igbos, Hausas, Fr.rlanis and Agatus exist and cohabit peacefully with the indigenes. The State is essentially an agrarian state with about 7\ohof its population engaged in one form of agriculture orthe other. In addition, it is a State that is internationally recognized for its rich cultural and tourism potentials.
Com mu n icati o rt systern (roa d...)
The major roads in the state are tarred but access roads to most of the endemic cornmunities are in poor condition. Some are only passable during the dry season. Despite this transportation by road remain the major lneans of comtnunication among the comtnunities. I.E.C. rnaterials, electronic media and the use of cornmunity torvn crier, announcements in churches and rnosque also fortn part of the communication system used.
A dnti tti st r ul iv e sl r uct ure
The state is rnade up of 30 Local Government Areas with the Chief adrninistrative officer being the Chainnan. A legislative arm made up of selected councillors from various ward suppofts hirn. At the State level the Executive Governor is the head of adrninistration supported by an elected legislative ann and the judiciary. The capitalof the state is located in
Osogbo.
J wHO/APOC. 26 September 2003 Heulth systent & health cure delivery
There is an official PHC system and it is implemented in the project area. It is a system where heatth care services are taken to the doorsteps of the rural populace. It is a systetn where community participation forms the mainstay and thrust of health care delivery with support frorn the UN agencies, the State and LocalGovernments. Levels of functionality however vary across the state. Within the project area there are 3 teaching hospitals, 9 State hospitals and 330 health facilities scattered throughout the entire State.
1.1.2 PARTNERSHIP - Irtclicste the partners involved in project intplementation at all levels (MoH' NGDOs -
notio nal, i nter natio nol) The partners involved in project irnplementation rvithin the project area are UNICEFA',Iigeria, NOCP (National & the B - Zonal offices), the State Government, the various Local Governments and the endernic communities. An international NGDO. IFESH is a partner in Irervole LGA where it oversees mectizan distribution, together u'ith other programmes aimed at educating and empowering communities to develop themselves with little assistance from outside.
- Describe overullworking relationship among purtners, clearly indicating specific areus of project activities (planning, supervision, atlvocacy, planning, nrcbilizution, etc) wltere all purtners are involved. Overall working relationship among all partners is cordial. However, the project personnel at
State level is not fully involved in the activities in Irewole LGA being supported by IFESH.
This has been broughtto the attention of both LG authorities and IFESH officials.'Ihe State
and LGAs through their various units are involved in training of field personnel, cotnmunity mobilization & health education, management of side reactions, planning and management of project irnplernentation, supervision and monitoring, and Mectizan procurement and delivery. UNICE,F is involved in supervisory, advocacy and training roles and assists in logistics provision. The Zonal and national offices assist in supervisiot't, rnonitoring, training, advocacy, Mectizan procurement and evaluation of the programrne. The communities play
such roles as selection and remuneration of CDDs, collection of Mectizan, detertnination of
mode and period of drug distribution. census update, Mectizan distribution and recording and reporting of treatments.
4 Wl lO/APOC, 2(r September 200-) Sf atu plans rf any to ntobilize the state/region/district/LGA decisiotumukers, NGDOs, NGOs, CBOs, to ossist in CDTI implementation.
There are plans to rnobilize the new policy makers that will be elected by March into the Local Government positions. An atternpt was made in 2001 to mobilize CBOs to support the CDTI irnplementation process. The project hopes to revive and revitalize the prograrrme so that they can actively assist in sttstaining CDTI in the State.
5 WIIO/APOC. 26 September 2003 O U OE LJ') ra O o- lr) al = tn F (-- ca t-* tr- o\ o, t-- .f, c..l aa r- a) p \r C.) F- aa o. $ O o, F- \o \o aa tr- F- $ E =::v co co $ $ o\ \o .:! co tr) c.l v-) o a.l @ \o u \o ca Ir- aA o- co an $ N =i- u \) a a1 \o ! q) ,o al a_ -oo U ! .= o.N c _.: r:< tr a o co F- tr) co $ oo I-* lr) @ 6 ! F 3; co $ \o F- c.l \o \o ao N F- o\ o o co \o tr- $ \o co v O o. F- .f, $ -i o- c.l o\ t--. c.l co oo oo \o c-.l aO \o \o oo \o aa t-- bo v $ s $ C\l $ t-r r-
tr o :'': o , oE E o- $ () F. L B.E.=; oo C..l O (f) (J >,! o o) t co $ co \o N co \o tr-- @ o\ r t-- t-- $ V-) F- F- c.l \o r/') oo CO o\ ao $ tr-- N= O \o co C.l CO v s t- L 'E:Fo tr.=; r- L ;ou $ $ ao r-- aa o. t-- V') \o ca '+ o o\ t-- c\ F- .f, tr) N .I o:L \o V') \o C. $ co trr F- N (-- =f, t-- ia 0) 2='-l o aa o. co aa $ ol O -f, =i- aa (.) LI L C) ON ()L v) (,) -q) o b! \o Eq) -q $ o\ O (o ao c.l oo CO F- a.l o' aa O O O F co aa c.l $ \o o.l $ co 0) U) c) '=q) L: qr.tr i 0) (,) >)o C! t--- N o N .O F- co t-- N co r-. $ t-- co o q) I Lt' o.= E:9 +avoz z ;ou O.r cn CrE: c- $ N o F- \o sf F- co (-- co N oo $ .O O tr-. o *ro z $ F- c..l c.l $ \o o\ co tr-. o=IEE E3 trs, 9Y- t,o. f.i 6 L= d!:.i oo tr- aa O w oo r\ oo 6 IEE o.: oo s \o t'- oi \o \o a.) o\ c\ tr- o\ 6 = co \o r.- :E J.=a c =a-tors-\ -i o ?s!='\ ,o 6i: IJ 61rt^{ .G::+S\ a -oa \t'\to o \i tr- 3 \j o-o \ IJ C- \ SEGTION 2: ImPlementation of GDTI 2.1. Period of activities Insert Plan of action indicating activities by month, which were implemented 8 WI IO/APOC. 26 Septernber 2003 I l- a o o a (D' to) o CD .D' o' 0a o o o - o o' 5 c0 o o lD o o a a- 7r l0 Lll o o o- o- laD 9D o o a- .D FD o a pD o = o .0- l* 3 ar Et - e o o .D o l- ; a= a c0 5 .D (-D a .D o I o c c o c o C C c c o o o o o c) o o o o o o .) o o .) .O .D o o o o o o o o o o tt 6 6 6 5+ ari o- o- (D a' CD .D o rD o rD o o .D o oEt Eto o o I t I - - '.t - - - 0a - .D 2. 2. z. z. (l t z 2. z z z z z z z z. z. .D o o o o o o o o o OE a o o o o a) o (.D o .D o rD o o .D o 3 3 3 3 Et o- o- .D d d 6 = C = = (D .D - CD o o o CD o o .D o o o o o t t I o ------o- c c o o o c c - c c o c o o o o o o o c) o .) o o o o -u) o o o o o o o o o o o o o d o- 6 o- d 6 o. o' 6 o (} .0 o .0 .D o .D o o .D .D o o o .D o - t - - - - rq i - o- rl t'l .n fl rl ,i1 \ \ \ E rl il \ o o .D .D .D .) o .0 o o o o o o o o Y d o- o- d o- d C rc o I I n lD C- - c t- - tr- - co t0 FJ- FD -FD ID- - TD- -CD tD CD co - - a t(\ G \o U t-t cj - U 6 o .D .D o o .D o (D (D o o o (D rD o o .) o o o o o o o o C) o o .) .) -u) .D .D (D CO rD o o CD o o o o o o o (!o * ts 3 3 3 ts 3 3 ts 3 d d 6 6 6 d 6 6 = (D oa a .D cD o o CO o o c0 o o rD o .D o - - - t - - - I - I a rl Tl E \ fl t, \ E rl t) 'n \ fl fl L) o o o rD .D o (D o o o o o o .D o (D o d o- d d d o- d d 4= I I I >.t O- C------l0 = tD Fo c0 FJ = CD ;tD o \ t - I - I ts 5 5 t I o 4% G pD FO FD F0 ED lD CD FD FO _(n CD ID CD ID FD c0 P ID l0 Ete0 t I I - - - xa 0a (D 7 7 7 ? 7 z 7 7 o F0 l0 CD l0 TD ID FD c0 F0 Y Y k F- o c c C c c c c o c c \J c o o C) o .) o o o o o C) o o o .) C) _a c o o o o o o o o a o o o o 6 6 d 6 d I 6 6 6 o' i (D o .0 .D rD CD o o CD o o o o CD o a I Et Et I -t 5 I t IJ - - - - ocl (/) (D o a 7 7 7 o (n 3 FD tD CD FD CD FO F0 FD tD C' G oi N) o 2,2. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtleose tick the appropriale answer) MoHNocP{tr Iwno truucnr trNcoo Other (please specify) Mectizan@ delivered by - Qtleuse tick the appropriate answer) MOH/I\OCP ./tr tr WuO tr UNrCnn' tr NCDO Other (please specify): Please describe how Mectizan@ is ordered and horv it gets to the cotnmunities Mectizan is basically ordered by NOTF via UNICEF and based on requests frorn the State. The State Project takes delivery of drugs from the FMOH through the Zonal Coordinator. LGA Coordinators get their consignrnents from the State store based on their respective estimated requirements in accordance with their specific target population. In likemanner FLHF takes stock of their own drug consigntnent from LGA Coordinator for onward delivery to CDDs in endernic comrnunities. Tabte 3: Mectizan@ Inventory (Please add ntore rov's if nece:;saty) StatelDistrict/ Number of Mectizantn trbl"ts LGA Requested Received Used Lost Waste Expired Atakunmosa 125526 140736 r 00000 7 West Ayedaade 133602 143961 96711 15 Avedire 122229 141309 5 8000 2 Boripe t44630 114166 88972 8 Egbedore 211212 140871 r 08840 3 Ife Central 865 56 80.1 l 3 67646 2 Ifelodun 139377 100,000 99329 2 Ife East I I 3616 I r 4068 90208 5 Ila 200226 I 50000 144239 12 Isokan 178734 I 80230 92000 6 Iwo 260298 87019 76619 I Obokun 195486 112915 104843 4 Oriade 1A3692 I131t4 I r063r9 9 Orolu 212112 86892 66842 l3 1300568 89 TOTAL 2227296 1648400 10 WHO/APOC. 26 September 2003 - State qctivities under ivermectitt delivery tltst are being caruied out by health cure personnel in the proiecl area. The health personnel at the various levels have been responsible for the follorving: - An! otlter comnrcnts 2.3. Advocacy and Sensitization Stote the number of policyktecisiort mokers mobilized ot each relevont level during the current yeor; the reasons for the sensitiZutiott urtd outconrc. Describc rlfficulties/constraints being faced and suggestiorts orr ltow to intprove odvocacy. Policy lrakers at allthe l4 endernic LGAs were sensitized and mobilized to support the CDTI irnplernentation process through advocacy visits during supervisory trips to the LGAs by progralltle staff and external persons/evaluators. In addition during the rnonthly rotational meetings of the LOCTs with the SOCTs, LGA Chairmen are usually invited to give key note addresses. The rneeting provides the forum for interaction with the Chairrnan, and for him to shorv case rvhat he has done for the implernentation of the programme. With the frequent changes in policy nrakers at this level and the low levelof funding these advocacy visits were absolutely necessary. Sorne LGAs have responded with government counterpart cash contributions being rnade available, and some have supported the prograrnme in order ways. The greatest difficulty has been lack of funds to hold advocacy and stakeholders' meetings and to interact more with the LGA policy makers. so that the issue of counterpart firnding for CDTI will always be on the front burner. We also need to involve State policy makers to routinely visit the LGAs to solicit for counterpart funding. At the State level, the project has relied more on external persons like UNICEF and NOCP officials who cane to visit the project to pay advocacy visits to the policy makers. Not rnuch have been achieved in this regard except a promise to include the sttm of l0million naira as counterpaft fgnding in the year 2004 budget estimates. There is need for a high- powered delegation frorn APOC management to visit the State and solicit for government cash contribution. ll WHO/APOC. 2(r Septerrber 2003 2.4 Mobilization and health education of at risk communities Provide informution o n: Media Used F Mobilization The communities were mobilized through jingles on Local Radio stations i.e. Radio Nigeria & Radio Osun. Town criers, Public address systerns mounted on moving vans, IEC materials like posters, handbills; and village rneetings were also used to rnobilize the endemic communities Mobilization And Health Education of Women And Minorities Generally, there are no problems rvith minorities within the project area. They participate actively in all cornmLrnity decision rnaking processes as they have been accepted as being parl of the community they live in. There are the Agatus in Oriade LGA, who travel out after the farming season back to their places of origin, to return at the beginning of the farming season' However, treatments are arranged before they depart. and they participate actively in health education and mobilization sessions. In Osunjela community in Atakunlnosa West LGA. the CDD is from Benue State, and he also doubles as the community's rnobilizer and Secretary. In Dindin Obaloja in Ila LGA, an Idoma also from Benue State has been selected as the CDD. Women participate in health education and mobilization sessions, but in srnaller numbers than their male counterparts. This is because they are constrained by domestic activities they are engaged in. There is also the irnpression for those married that once their husbands parlicipate in the meetings their interests are taken care of. Women also have respect fbr their men when they participate in meetings, and therefore lirnit their contributions. Respect for tradition and culture demands that rnen should be allowed to have their say over the women and to take the necessary decisions. Despite this women still participate, and many have been appointed CDDs. The project is actively encouraging the participation of women, especially with the inclusion of females in the mobilizing teams. Rcsponse of target communities/villages The communities/villages mobilized responded to the rnobilization and health education carried out by the SOCT, LOCT. First Line Health Facility Staff and the CDDs. They came forward to collect their mectizan,and in some cases gave incentives to their CDDs. Some gave funds for CDD training. There is more awareness of ivermectin benefits, tnore involvement in 12 WHO/APOC, 26 Septernber 2003 decision rnaking and villagers make more efforts to encourage potential refusals to take ivermectin Accomplishments (1) More community involvement in decision making (2) Increased levels of awareness of ivermectin benefit (3) Villagers make rnore efforts to encourage potential refusals to take ivermectin (4) Communities came forward to collect their drugs. Weaknesses/Con straints The major constraint is inadequate funding frorn all sources for constant interaction with the communities by FLHF staff and LOCTs. While some of the FLHF stafTand LOCTs are doing their best they are being hampered by insufficient funds to carry out allthat needs to be done' This is coupled lvith the inadequacy of motorcycles for district supervisors and First line health facility staff so that their rnobilization visits would be made easier. Holv Mobilization of Tarset Communities be Imnroved (parlicularly women groups) with necessary mobilization skills will help a great deal in irnproving mobilization of the communities. comrnunities. l3 WI IO/APOC. 26 Septcmber 2003 O b! N 6! c), -o E c) aO o. $ o. <. co <- \o co a.) \o aa \o \o co v ca c\ a.l @ \o O .!r, a \o tr6 N '.1 = rO o t \i E'= o s=dE E- z==:FF Z o\ rr) t-- aa co (-.l \o t N o.l \o (-.l o. ol ca N c.l CN \o ca tr) $ o\ ('.1 F c.l F- $ tr- $ c.i ca F- ca N an N (..l c.l N ol oo c.l c.l I 9- t--- c'l ca \o F- o\ \o ca t/^) V') \o (r) ao \c) C..l \o $ r- H $ U \o aa E \o s ca al ca O \o N co N N r-- r- ao oo $ Z N t-- -i\ E It a oq aJ- \ \ n U \o oo @ F- \o \o N ca N tr- q) I (-- \o ca (-.l co $ s'7 $ \o c\ r- $ o= 4 >? f, >.2 p ?o ?_'= ? 7 .-L 9 tr-6 i .lP tro etrEX G6 :5:= ao (-'l E9 Zeca co N O O oo O N ao LS c.l $ N ca c{ co c.) C.l c.) V) iE rf oB L?ea aJ e= .r.:.= I o3 rEErr oe 7a -=9:SEgU o$, -o tr $ o\ E ='3 O ao o.l co (-I ao (-- co O O co aa $ N \o \o a.l $ F= +,U tro a ,r? q \ 09 o€ a L oo co t-- o, ao (-N $ co aa E.= \o w af) $ ra) tr- aa Os .= ,; q=L eF OE E d >A ::- J-i - tr'5 \; - ?a \o <. c..l F- c..l $ @ co t-- F aa ao C. aa co (-.l $ s OE z.= aa t $ $ Oo- E t.'= Sr *,() I ?.= ;hg;eJX-e! )= ': E: -E.i oo 7. o 1...r N 4E=:!e r c{ O t-- O O o EE -9-, \o \o (r- \o r- \o \o t--. r= F- t-- EE ^ I O (", a (, :. o () =f,1 (.) E .rl J cO o ./) L OJ o ro 5l E 0.) . cdl a- () L o (.) ,o O o i! )l o o NFI (s o -o eiZ o r!oo ,o ,C) ,o a c c c \i O Q CI o _o E a) E\J L o .+aa o aa \-- 5 a 4= \c U- c! q ;r ISc)4 j qeu,tr o =- I .=S :EeP € u e.= = $ € _a o[ ....l t \UaG) ;v ,69 ?a q, -C C) @ ae() $ t-- (\l H!'\ oo AG- -X \J e.- Tl- = dil \u6:^- -v) v) IPJ $ t.- ?)La-co Oa q-o=.- =' E9L\)=o) (f) \.)oo ca \ '^! -r() N E.^ :v / 3F>a %s- = oo : '" c-r 's:Fi6th bq r.- 9L r- U!t, v .j .a = =: =!'Jv a s<\E = .: \- oJ cd \r. !S'gq, h trad ,l \94s^\ :'S ..6 U' c -S 61o? ao N \i-Li9 aa =f is€s :.*6= E :.$ i -(€efr '- {-r\- >L.- o -\\-r'rA .- i o aa rr.)csE ==--^L co .=(JE o ==.i E '5- v+L)P: Vv^.! co rA E [n iE*s,\F e ts: -::,: .C-.i,-r-v,)U iELaa-2tr ra : \ r i.= ra ss; r.) ua\ -tr-= ll sL!.=E -u;Y^!;a .v^)/sts u: :\s-I 'o'- \ !'* r! r- .S u -- .- yi.: = i ! ::vts\!:L =Us =Si=e: ! g {!r :E\ i v.\S'Crt* st -!.- 5 .P oc '!r.'-= ! E .{ JA i.o t P =<.l.\].-6 U r r {! o! ' o F 2.6. Gapacity building 2.6.1. Training WHO/APOC, 26 September 2003 t6 al 0|o co -o F V) co co oo oo O O o\ d O (r) r/-) <. aa $ (c' -f, $ : : o- : l a o al a ca @ oo aa v-) \o t'-- o\ c\ \o o. c.l c..l c..l .d- CO c-l ca ca 1 : : : l : : : 0) O (.) o o- o o) z. \o ao V) co co V') co o o t r- I c.r L oo c.l (, z ? s F o r O =f, oo V) co o $ $ V) \o \o $ $ $ \o (r) $ $ N a F O o 6J : .=iFF tF o () %a (,) aJ o ,Q't (.) q) AJ t-F (, I = z -L o s a) bC (9 \o d tr) t a.l \o O oo ca oo . s )t \) 0) a ]E tr- O O aa Ir- ca @ C" o ! \o N O O $ aa (f, q) \) CA N c.l c.l aa a\ C\l aa aa O I e1 l: I c) () q (\l 0) o v^) \o @ s o.l co $ \o oo o\ $ N F- o z p () o o\ p L co @ O rn $ oo rn o c E c.l O O o (-n aa rO 0.) ca $ ca ca ra) N $ $ ao aa $ c\ It, la F \ o F q - (oo s S cd L .. F () () :: J I lq o c0 o a () () (.) -o E a = E o () o LL] o - = o ! -o o o o bo ,() .o cd o -o ,o I a (-) H c0 p c o 3 Table 6: Type of training undertaken (Tick the boxei where specific truining wos carrietl otrt during the reporting period) Trainees Other Health Community Workers rnembers e.g (frontl ine Others Type Community health MOH staff Political Leaders (specify) of training CDDs supervi sors faci I ities) or Other Progratn lnanagelnent How to conduct { ./ Health education ^/ Managelnent of SAEs CSM ^i SHM Data collection ./ i Data analysis ^/ ^/ Report writing .{ ./ Others (specify) - Any other cotnments 2.6.2. Equipment and human resources Table 7: Status of equipment (Please add more rou,s if necessary) Source APOC MOH DISTRICT NGDO Others /I,GA Type of Equiprnent Condition of the equipment * Please state 1. Vehicle 1 (Functional) I 2. Motor cycle 20 (15 non - 39 (2 functional; functional, but others grounded) repairable) 3. Computers 2 (Functional) 4. Printers 1 (Functional) 5. Fax Machines 6. Bicycles 70 (Functional) 105 (22 functional; others grounded) 7. Others a) Photocopier 1 (Functional) b) Proiector I (Functional) c) TV Monitor I (Functional) d) Generator I (Functional) *Condition of the equipment (Functional. Currently nott-functional but repairable, Written off) WlIO/APOC. 26 SePtembcr 2003 \B How does the project intend to maintairt and replace existing equtpment and otlter materisls? At the LGA level, the Local Government sometimes give imprest for the maintenance of the project motorcycles in their respective Local Government Areas. Storage facilities were also provided for the safe keeping of allequipment. They are also being encouraged to provide the necessary materials for CDTI irnplementation. LGAs such as Boripe have been very forward in meeting most of the needs of the programmewithin its area. Atthe State level, the capital equipment and other materials available for the project will hopefully be maintained from the lnoney approved in the State Budget allocation for the Oncho. Programme execution in the year 2004. On the issue of replacement the project is reqLresting APOC to replace the project vehicle and other capital iterns supplied earlier while efforts continue to get government or UNICEF to replace them on the long run. - Describe the udequucy of availuble knowledgeable manpower al all levels. There is abundant knowledgeable manpower at every level of CDTI implementation in the State, but not all are being utilized. There is need to train rnore health facility staff to be involved in the progralnrne. I - Where frequenl transfers of truined stuff occur, state what project is tloing or intends to I do to remedy the situtttion (The mo,sl intportanl issue i,s v,hat mea,\ures were token lo ensttre adequale CDTI intplementaliott y,here not enough knov,lcclgeable nranpower v/a,\ tts:ailable or stctff often transfbrred cluring lhe course of the campaign). Whenever new staff was employed or when trained staff was transferred, training was ttsually organized for those that replaced them or the newly ernployed one. The State Project also intends to liaise with Local Government Service Commissioner 1'or the retention of Oncho. Prograrnme Officers forlonger periods of time the purpose of continuity. Ort tlte long run the best thing is to train all healtlt workers on CDTI. t9 WFIO/n POC. 26 September 2003 I I 2.7. Treatments 2.7 .1. Treatment figures I I I I 20 WllO/APOC. 26 September 2003 =a.1 E Or^'=AeE o -o = ra;* f o 2 o P US al o(E o z o. O dg I I I I I -o I E O o- 9LC o +< a 2z=.^ at I I cL.) lu v co .i- -t F- E9 oo oo t-- I=. \o O c.) 'r a- $ $ o. O c.l \o $ z6 t-- rr^) co s co \o co ao : v- Q 3 sp P co r6Eir2A dP O co O co z g! O \o $ O o.l ca $ ca I-r aa s1- C.l a.l aa 'io fbo O 5^ Q!:ro ooL>- EO 6l c.l o t--. C. V') $ $ F- F co co co oo r- co \o oo r,- \o $ F- oo a% q) a a_ U .f, a) @ C' \o CO @ N o\ \o oo ao a{ N co @ o\ oo O z?3 r- (-I t'-. w ol t-- oo tr) aa N =H: .f, tr- ca aa N N o\ O z- ca .O aa .i- V) (..l ca ao 'n- an <- aa = O c0 q) dO= ol \o \f, a.l o\ aa th o .9 s.r L 5oi":- oo\ A O O O O O Y; O O O O O ()l6 o 501 E.e - J dt ! o -l = "',,! I L ! 5 =:.- $ o. a tn za O aa N co a.l t-- aa O o -o 't I oo s1- N \o \o c.l $ >) Eo a fr.l E oE .l 9s' $ o\ a -tro C. (..l oo N ca F- O1 ca O r/-) oo co \o E U $ N \o c..l $ 0d \Oa :.e= b ij Y,-^= 0) + Ill s =.=o> =tr o!9 =tr =a-dlaa $ O o O aa a.l @ a\ aa r- o\ aa O FL O co aa $ an \o \o a.l <- cicir () cO I !.) ! 6-r i o '-\ E (.) O U) -ot-t :r: o .J 6Y f ! () FI o (J Q I! J -!o ^< 6JO -o (.) (.) o o co ,() , , o -o iB q tr.l IA c c o CI bo u s -o l oE o. O U a al \c I 00 o 0O lo aa o \ 9 () \q) $ 6 ! @ rrVU s o] O o )L '= J. L o\L! o o iU L (J o d c.l ct) ?..i t (Y) (.) .:1, E \ 6) ou$ .=1 o O-.=: oL () rrl i'U-t L! -: tr- o C ,= -o }.ES .= ! DiJ (.) ds! (o 9i'a t (J \o (Y) tr (-.l O .d- (f, .; L'! ao ta) =a ;'is= E tE.= a E () o lsi (0 (.) ()\i oo o .9 P*s $ L ^:v O (e () O €sE \o (c' 'o E a'-\ c.l X o f,P c..l c.) 9L . sqeV ts (o _b &R o .\ !-5 oo () () \ !\ ! -a\ C6 : i 0) : i: () co br) ! \-%S I! (n () c-) -o (-) \ E! (.) d (9 o I o O a .9 O =k\ a. oo L ': ci L^ o !. :u q .94 '=X o\ o u\ 0) o () t\ t\ \' -J a. J CN F lrll: I oo o c-) o l s 9! o -c (-) F l\ !..: L t-r ,- O \o o F - If the project is not achieving 100% geographical coveroge and minimum of 65% therapeutical coverage rate or coveroge rate isfluctuating, slule reasorts ond plans being nrude to rentecly tltis. The State has been achieving 100% geographical coverage and more than65%o treatlnent coverage in the last two years. I 2.7.2 V4hat are lhe causes of ubsenteeisnt? The absenteeism experienced in the treatment is characterized by. -/ Comrnunual crisis leading to displacernents of sections of the cotnmunity community have gone to their farm steads or other engagements. 2.7.3. Briefly describe oll krtowrt ond veriJied serious arlverse events (SAE| and provide in tqble 9 the required informotion when awiloble. There has never been a period when sserious adverse reaction occurred in the state since the programme inception. 2.7.4. Itt cose the project hus no cose of serious utlverse event (SAE) during this reporting period, pleuse tick irt the box. No case to report L) WHO/APOC, l0 April 2003 ooL EaL :oe at i -=etL- .l t_, o. ,J2a rr' D bI) :' u .=Ji (, 60@ Ae:1 l^L c qoo :r I C^ q,! % e.a a,) U oE 6- :q o*a a.C U ^ o .= c) o-c tr .: S AJ *6 % oa-n ci q) J E EE;- rIJ :3 .: v u : : t o L tr O , -=*. o- , Jr,s,a= 2, u= DO a'= r L d E.=.8 o o. $ Lo N = (.) 5 - !, oo'N ; ;,5.E 8 50 E;-6s> I .1 L 'o () ! o L o E O o I o o. E a < a t! C) ", o- O a EE o- a C ai I L C) d () N .D (J L O2cS o AJ a o o o btl q) L .J o cO q- o I + t ,- L a ,< q) (J O -a a Cd + U bo o.r ( o.r o,l q)\ -l q -ot(Bl FI Ax ox- l-l NJ tJ I.J N.) N) t.J NJ N) TJ NJ N.) l^.r O O O \o \o ld O O O O O o \o \o l- \o UJ NJ \o oo laD O oo { o\ 5 lp .)} (Jr o 15r(,J 6a { J UJ C,= IJ u.) UJ (l) oo O @ b's s i 6r' = =a :\< -@ + .D: a Pr'=E. >q =^ tD :- p ad a Ita l) (t' J5 @ -J ! (^ o= z NJ UJ o+ (/J UJ Lar ,JcioJ- t ogi da o G !i ^: a,*z'g 3 h 3 .DlD l:c (D -l 5 o\ 5 = t\ lo+ ! { Lrt -.1 .D a UJ ().) oo o\ o \o t-: 5 afi 5 e tr l*o o- oao l-Y rD tD o\ NJ \o O O \o oo u.) oO o O -.t .o @ :.4 0q U6 -a o o; \o o\ \o \o og O \) (/-) O o O c- s;d tDa m-o o c:.o fD2 \] ! ! \o o\ o\ G- o: N) +- A O (,fl N) NJ !96 A A ! e4 E- \o (, UJ o @ NJ NJ o,: o e; oo O P-O Yi.s _ :6 (D .dC : o o\ o\ \] (, LA o\ (}J t N) A o O oJ- o .oci P O o ae-= Io { o5= o d1 (! s ()) A N) UJ oo ! N) (J.) + )J @ j-J \o I t/.) N.) N) 5 o\ t-J N-) oo ! \o a.+ O N) A oo .ir=o o (o 0 o a ! o\ u u o\ s J El O oo oo oooi vpd -! oo=@ o oo @ { 5 o 5 ! s O oo o- o ? (,l ? otD :- ai r'l IJ m- o\ o (, N o -o oo { o\ oo 5 o o UJ oo \o \o -: 2.8.1. Provide aflow chart of supervision ltierorclry. ZONAL ICE STATE MINISTRY OF HEALTH + LOCAL VERNMENTS FIRST LINE LTH FACILI (FLHF) COMMUNITY SELF MONITORS COMMUNITY DIRECTED DTSTRTBUTORS (CDDS) 2.8.2. k[4tut were the ntain issues identified during supervision. I Issues identified during supervision include: Inadequate registration of community members I 'r Lack of incentives to CDDs by communities ,r Poor record keeping at all levels Inadequate commitment of some LGA Coordinators to the implementation process especially when their expectations of monetary rewards are not being met. Professional rivalry among health workers, sometimes to the detriment of the work; as there are disagreements over rvho should do what. Some refusals who had mild reactions when they took Mectizan at the previous treatment cycle. 2.8.3. V[/trs supervisiort checklist used ? Efforts were made to use the checklist at the State level though not at all times. The LOCTs in most cases did not use any checklist during their supervisory visits. I 26 WHO/APOC. l0 April 2003 2.8.4. What were lhe oulcontes ut euclt level of CDTI implementation supervised The project is encouraging the use of CDDs as guides during irnmunization campaigns Refusals have been health educated and followed up, and there is a good level of compliance At the LGA level efforts have been made to emphasize importance of good record keeping, and several discussions have been held on the need to update censLrs at the community level. !n2004 the project with the support of UNIEF is planning a comprehensive census update in all endernic communities of the State. The LOCTs have also been encouraged to utilise the health facility workers rnore in programme implementation. 2.8.5. Ll'us feed-back given to the supervised, and how wus the feedback used in improving the overall perforntance ofthe projecl Usually, when SOCTs go on supervisory visits they go with the LGA Coordinators or one of the LOCTs so that whatever is found out is discussed. LOCTs are encouraged to go with the health facility staff in charge of the area they are supervising so that they can discuss what the findings. There is also a monthly meeting of LOCTs with the SOCTs, which is rotated arnong the different LGAs. This provides the opportunity to share the outcome of supervisory visits rvith all the LGA coordinators fbr their further action. It also provides the forum to review programme irnplementation and discuss the way forward. Community leaders are informed of I rvhat needs to be done where there is need. I I 1 27 WHOiAI']0C. 26 September' 2003 SECTION 3: Support to GDTI 3.1. Financial contributions of the partners and communities Table I l: Financial contributions by all partners for the last three years \car 3 (Oct 2000 Sept \ c'tr' 4 (Oct 2001 Sept \ear 5 rOct 2002 Sept 2001) 2002 ) 2()03) TOTAL TOTAL TOTAL TOTAL TOTAL TOTAL Budgeted Released Budgeted Released Budgeted Released Contributor (us$) (us$) (us$) (us$) (us$) (us$) Ministry of Health (MOH) r 0.289.00 r 0.289.00 10.289.00 I LocalNCDO(s) ( if any) NGDO partner(s) 48.070.00 2.622.51 -17.390.00 47.390.00 4.254.00 DistrictiLGA* 38.3 13.00 6.940.00 3 8.3 r 3.00 2"6 r 8.00 38.313.00 l0-856.30 Others a) b) c) Comrnunities APOC Trust Fund 95.860.00 79.891.00 58.780.00 56.709.00 36.905.00 20.000.00 II TOTAL t 92,532.00 n9,,{53.54 154,772.00 59,327.00 I 32,897.00 Js,1 10.30 * Figures reported by LOCTs. Details of expenditure were not given as at time of I reporting. IJ'there ure problems witlt releose of counterpartfurtds,ltow were they addressed? The release of counterpart fund by partners to the project rernained the bane for the smooth programme irnplementation. This is being addressed through routine advocacy visits and constant urerlos to the policy makers. I Conmtents There is absolute need for high level advocacy visit by APOC Managenrent to firrther sensitize the State policy makers on the need for counterpart funding. 3.2. Other forms of community support Describe (indicute fornts of itt-kind contributions of communities if any) Non - financial incentives to CDDs corne in such ways as : - food stuff 28 WIIO/APOC. 26 September' 2003 exemption frorn community labour clearing of CDD plantations by the community members selected for and elected into councillorship positions at the LGA level recognition at annual events. sometimes where special gifts are presented to some CDDs Such gifts include wall clocks and plastic buckets. I 3.3. Expenditure per activity - Indicate the expenditure on octivities below in US dollors using the current tlnited Notiotts exchange rate to locul curuency Table l2: Indicate how much the project spent for each activity listed below during the reporting period Source(s) of I lExpenditure I Acti uqr fundi I l=tq Drug delivery frorn NOTF HQ area to central collection point of - comrnunity I 2.654.29 I Mobilization and health education of contmunities APOC 3,398.87 Training of CDDs APOC 4,858.26 Training of health staff at all levels APOC/UNICEF 2,230.00 Supervising CDDs and distribution APOC 223.74 Internal rnonitoring of CDTI activities APOC 476.19 Advocacy visits to health and political authorities UNICEF' 77 5.94 IEC rnaterials APOC Sutnmary (reporting) fonns fbr treatment 4,005.15 Vehicles/ Motorcycles/ bicycles maintenance APOC 979.34 Office Equiprnent (e.g computers, printers etc) APOC r Others ,203.80 APOC/UNICEF 3,43t.25 Managerial Assistance APOC TOTAL 24,163.09 531 361 Total number of persons treated Comments 29 WI{O/APOC. 26 Scptcrnber 2003 SEGTION 4: Sustainability of GDTI 4.1, lnterna!; independent participatory monitoring; Evaluation 4.1.1 Wos Monitoring/evaluation corrted out during the reporting period? (tick where applicable) Year I Participatory Independent rnonitoring I I Mid Terrn Sustainability Evaluation I {- 5 year Sustainability Evaluation I Internal Monitoring by NOTF I Other Evaluation by other partners 4.1.2 Wltut were the recomnrendations? Recommendations at State Level Planning o The State level should consolidate 3 year sustainability plans developed, revising thern to ensure that they reflect variation in activities for each year, depending on need. o Sustainability plans should be integrated into the overall States health plan. Monitoring and Supervision o Staff at this office should undertake integrated supervision and monitoring with other related pogralntnes. The supervisory visits should be made as few possible and more directed to LGAs with identified problerns. and limited to the LGA level. Mectizan Supply o Mectizan ordering collection and storage should be re-directed to using State funds and other related resources. Training and HSAM o Targeted training and HSAM should be the way forward . The trainings should be based on needs assessment, few as possible and of short duration o SOCTs should limit themselves to training of LGA staff and allow LOCTs to etnpower lower levels. 30 WtlO/AI'OC, 26 Septerrber 2003 I Finance . The cost of CDTI should be reducing from year to year in the spirit of Sustainability. The activities should be few and simple to implement. o Plans of activities should be revised/developed based on resolrrces realistically expected to be available for each year. . High level advocacy is needed to sensitize the State government on release of counterpart funds. Transport and other Materials o A rnaintenance schedule should be developed for vehicles and equiprnent. o The use of vehicles should be integrated. o Transpoft and various equipments that are 4 years old or more need to be replaced Sources for such replacement will need to be identified and pursued. Human Resources o Staff at this level should be trained in computer use and information managernent systems Recommendations at LGA Level Planning: o In the LGAs rvhere written integrated plans areas rnissing. they should be developed. o The LGA should consolidate 3 years sustainability plans developed, revising them to enslrre that they reflect variation in activities for each year, depending on need. o Sustainability plans should be integrated into the overall LGA health plan. Leadership: o In LGAs where Health Personnel are not initiating CDTI activities, they should be ernpowered to do so while the practice should be consolidated in LGAs where Health Personnel are initiating CDTI activities. . The number of members of the health management team should be scaled down to two or at most to four. Monitoring and Supervision 3l WllO/nPOC. 26 September 2003 o Writing of Monitoring and Supervision reports should be strengthened in all LGAs. o Targeted Monitoring and Supen,ision should be established. o The LOCTs should empower FHF staff to undertake targeted monitoring and supervision independently. . Supervision visits should be integrated with other CDTI activities and health programmes. o Successes shor-rld be noted and LOCTs should embark on advocacv for CDD compensation at the LGA level. o Staff at this level should undertake integrated supervision and rnonitoring with other related programmes. The supervisory visits should be made s f-ew possible and more directed to areas with identified problems. . An integrated checklist for supervision and rnonitoring visits should be developed and put to use. Mectizan Procurement/Distribution . Appropriate records of Mectizan movement need to be properly kept. o Dependence on APOC and staff resources should be reduced. Training and HSAM o The FLHFs should be empowered to conduct targeted training of CDDs and HSAM, LOCTs should limit thernselves to training of FLHFs. o Training should be based on need. Duration and nurnber of trainers should be appropriate to need. . Where possible, training on CDTI should be integrated with training for other health activities. o The cost of CDTI shoLrld be reducing from year to year in the spirit of Sustainability. Activities should be fewer and targeted. o Plans of activities should be revised/developed based on resources realistically expected to be available for each year. o AlI LGAs should be encouraged to release or beef up their contributions to CDTI. Transport & other Material Resources o Governtrent resources should be used fbr purchase and maintenance olrnotorcycles . The use of motorcycles should be authorized in writing and integrated. . Logbooks should be used to trace rnileage. I 32 WI-lO/APOC. 26 Septenrber 2003 - a Replacement plan should be developed for the motorcycles. Coverage o A rnechanism for treatment of rnigrant population should be worked out. Recommendations at FLHF level Planning . Staff at this level should be trained to develop written plans for the CDTI activities. o The plan should be integrated into an overall year plan for the FLHF. Leadership o The FLHF staffs should initiate the kev CDTI activities Mon itoring/Supervi s ion o Supervision visits by health staff should focus more on corrmunities rvith proven problems. . Successes should be noted and reported and appropriate feedbacks given to the communities o Costs for targeted supervision by staff at this level should be built into the CDTI budget at the LGA level. o Appropriate documentation of Mectizan statistics and treatment data should be kept at this level. Mectizan Procurernent/Di stribution . There is need for separate order forms wich should be operated jointly by both the health staff and the community. o The FLHF level should fetch its tnectizan from the LGA bymeans of transport supplied or paid by the LGA. Training and HSAM . Health staff should ensure that HSAM activities are properly planned and carried out only when the need arises. JJ WHO/APOC. 26 September 2003 a The FLHF staff should be allowed to plan and conduct CDD training as well as detennine their own training needs. a CDD training should be based on identified areas of deficiency. Financial o FLHF staff should budget for CDTI activities which rvill be taken into account in the overall LGA DTI budget. o The relative contributions of all sources of funding should be clearly spelt out. o The LGA should provide a vote to the FLHF for assembling all reports concerning CDTI activities (coverage reports, distribution report, mectzan statistics and training reports). Transport and other materials o The LGA should provide a vote to the FLHF to cover transportation costs (for delivering all reports concerning CDTI activities to the LGA) and supervision and monitoring activities. Human Resources o Health staff at the FLHF in charge of CDTI activities should be allowed to remain in one posting for at least four years. e The Health staff should be properly empowered to undertake all key CDTI activities themselves. o All health facility staff will need to be trained on CDTI ora plan for imrnediate orientation of new staff put in place to ensure that frequent transfer of staff do not interrupt programme implementation. Coverage o Health staff should ensure that all eligible rnembers of the cornmunity are receiving treatment and repeat visits done to treat absentees. Recommendations at Community level HSAM . Comt.t.tunity members must be sensitized on the need to provide resollrces to offset local costs of distribution. 34 WHO/APOC. 26 September 2003 Financing . Comrnunity rnembers should be rnobilized to take decisions on appropriate forrn of CDD compensation. 4.1.3 How have they been implemented? The recommendations will be tackled when funds are made available to the project for the 6th year plan of activities. It must be noted that the Sustainability plans developed were based on the recommendations of the evaluating teatn. In the rneantime the project have done the follorving: a Detailed sustainability plans based on realistic expectations of what will be available have been developed. These plans contain targeted activities for efficiency and effectiveness. a The policl,makers are being sensitized on the plans and have been requested to ensure they are included in the overall budget at each level. At the State level the plan has been incorporated into the draft MOH budget presented to the State Assembly. a The rnonthly review rneetings are being used to address LOCTs on the need for targeted supervision/rnobilization, empowerment of FLHF staff to carry or-rt CDTI activities and training of more FLHF stalf for CDI'I. 4.2. Gommunity self-monitoring and Stakeholders Meeting Table l3: Comrnunity self-monitoring and Stakeholders Meeting (Please add more rows d' nece,ssary) District/ LGA Total # of No of Cornmunities that No of Comrnunities that comrnunities/villages in the carried out self conducted stakeholders entire proiect area monitoring (CSM) meeting (SHM) Atakunmosa 50 20 13 West A)'edaade 83 26 t4 Aiyedire 32 t2 8 Boripe 184 20 15 Egbedore 42 20 12 Ife Central i3 6 4 Ife East 61 t0 Ila 69 t4 6 35 WHO/Al)OC. 26 September 2003 - Isokan 231 20 l0 Iwo 109 5 5 Ifelodun 27 10 6 Obokun 40 t6 8 Oriade lt0 l0 12 Orolu 80 18 4 TOTAL 1131 207 '117 I Describe how the results of the community self- monitoring and stakeholders meetings have tfficted project implementotion or how they would be utilized during the next treatnrcnt c-ycle. I'he CSM & SHM helped in monitoring CDDs before, during and after mectizan distribution. E,rrors in updating were corrected. They equally sensitized the community heads, clubs and associations to fund Oncho. programme. Overall these have led to increased cornrnunity participation, maintenance of 100% geographic coverage and increase in treatment coverage 4.3. sustainability of projects: plan and set targets (mandarory at yr 3) What arrangetnents have been made to sustain CDTI after APOC funding ceases in terms of 4.3.1 Plonning at all relevant levels. As a follow up to the evaluation exercise, a feedback and planning rneeting was conveyed at State and LGA levels. The meetings provided a unique opportunity to have the SOCTs to develop a 3 - year sustainability plan. At the LGA level, policy makers together r,vith the LOCTs and SOCTs were all involved in developing sustainability plans for CDTI activities. The plans were developed based on the basic CDTI activities and, above all, on what is reasonably expected to be available for project implementation for each year. This has set a pattern. which we intend to continue. 4.3.2 Funds This is a crucial issue. At the State level there has been little or no counterpart contributions since the inception of the project. The State and LGAs, supported by NOCP (National & Zonal) as well as UNICEF,Nigeria. are working on getting Government to release funds based on annual PHC budgets. The project intends to hold Stakeholders meetings at LGA & State levels. Meanwhile the State government has budgeted the surn of l0 million naira as 36 WHO/APOC. 26 Septernber 2003 - counterpart funding for 2004. The project has also been guaranteed some level of funding from UNICEF till at least 2007. Funding for 2004 is up to, but not exceeding $ 15,000. and amounts will go down over the next 4 years. At the LGA level the project is following up on the suggestions reached at previous advocacy workshops that LGAs commit some minimal amount for CDTI in their LGAs. 4.3.3 Transport (replacement ond muintenance) As stated in the earlier sections of the report the project expects APOC to replace transport before it finally withdraws funding. This applies also to other capital iterns such as computers. printer, generating set and TV rnonitor. Given the state of the econolxy and the allocations frorn the federal government the government may not be able to procure a 4 wheel drive in the nearest future. At the LGA level the National Prirnary Health Care Development Agency which is supported by several international NGDOs occasionally procures motorcycles for NIDs which are distributed to the LGAs. These are and can be used for CDTI activities. With respect to maintenance it has already been highlighted that LGAs release rninimal amounts for tlie periodic maintenance of the rnotorcycles. We hope this continues. 4.3.4 Other resources What has been stated for the section on transport replacernent and maintenance applies also to issttes such as provision of IEC materials and other resollrces needed for CDTI implementation in the State. If the arnount budgeted for2004 is released the project is confident of procuring some needed rnaterials for CDTI in the State. 4.3.5 Pleose provide a written plan with sel torgets ond achieventents for so far. A sustainability plan has been developed both for State and LGA levels. They are being made available to APOC Management. The sustainability plan is based mainly on recomrnendations of the evaluators and the basic activities that need to be carried out. 4.3.6 To wltot extent hos the platt been implemented 5t WtlO/APOC. 26 Septembcr 2003 E 4.4. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration 4.4. 1. Ivernrcctitt delivery mechanisms Ivermectin delivery has been fully integrated into the Prirnary Health Care strurcture. PHC facilities are used for drug storage, delivery and as well as for supervision. The CDDs go to the nearest health facilities to collect rnectizan. 4.4.2. Troining Some other LGA/PHC Personnel, apart frorn LOCTs. have been trained on CDTI so that they can assist in training of lower level personnel and supervise CDTI activities 4.4.3. Joint supervisiott and nnnitoring with other progrums At the State level, there have been discussions on joint supervision and monitoring at present, and a joint monitoring committee exists under the M & E section. However, not much has corre out of it. At the LGA levelwe are aware that some of the LOCTs are involved in other programmes and occasionally use the opportunity of visits to the contrnunity/health facility for one progranlme to look into other prograrnmes rvhich they are handling. At the health facility level, where health personnel are involved in CDTI the situation is even rnore fluid. Visits to the community are used for several purposes. There are however no integrated supervisory checklists, and none is being planned at the moment. 4.4.4. Release offunds Release of fund CDTI activities has been integrated into the existing PHC structure. Budgets are prepared and funds released within the overall PHC framework. 4.4.5. Is CDTI irtcluded in the PHC budget? At the State level there is a line itenr for CDTI in the PHC budget. At the LGA level CDTI activities are subsumed under a general PHC budget. 4.4.6. Describe othcr lrcalth programmes that are usittg the CDTI structure untl how this was uchieved. What have heen the ochievements? No other programme is using the CDTI structure at present but the State Coordinator and his deprrty have attended prelirnniary workshops on Vision2020 and lyrnphatic filariasis 38 WHO/APOC. 26 Scpternber 2003 - elirnination. At the comrnunity level, some CDDs are used as Local guides and vaccinators during NIDs. 4.4.7. Describe others issues cortsidered in the integration of CDTI. 4.5 Operational research 4.5.1 Sumnnrize in not more thort one half of a puge the operotional research undertaken in the project area within tlrc reporting period. None was carried oLrt during the reporling period 4.5.2. How were tlte results applied in the project? N/A 39 WHO/APOC. 26 Septcrnber 2003 I l SEGTION 5: Strengths, weaknesses and challenges List the strengths and weaknesses of CDTI intplementation process List the challenges ond indicute how they were sddressed. STRENGTHS l. Sustainability plans based on realistic budgeting exist, and these can be built on for an effective and efficient prograrnme irnplementation. 2. Increasing political support for programme activities from chairmen of LGAs 3. Moral and Adrninistrative suppoft frorn the Authority of State Ministry of Health. 4. Integration of CDTI activities into other PHC activities, particularly at the LGA level. 5. Appointment of some CDDs as top political functionaries in some assisted LGAs in the State. Greater support is therefore anticipated fiom such LGAs, if they continue in office. 6. High level of comrnunity ownership: Several indicators such as number of communities selecting new CDDs and collecting their Mectizan from pick up centers show an appreciable level of community ownership. 7. Availability of highly cornmitted Health Workers to CDTI activities especially at State level WEAKNESSESS 1. Non-Provision of incentives for CDDs by most communities. 2. Non-provision of counterpart fund by the state government and some of the assisted LGAs 3. Late rendition of returns fronr LGA Coordinators 4. Late release of fund by APOC authority 5. Poor record keeping at all levels 6. Lack of basic computer skills by SOCTs. 7. Inadequate logistics 40 'r\/HO/n I'OC. 26 Septcnrber 2003 t-t 1, I CHALLENGES Strike action by the entire work force in Osun State for a period of 3 rnonths. This disrupted implernentation of planned activities. Although CDTI activities were still carried out these were done with a lot of difficulties and on a minimized level. Lirnited involvement of Health Centre/Post staff in CDTI activities. Inadequate rnotivation of CDDs by the communities. Lack ofadequate census update Rekindling the interest of Local NGOs and CBOs and enlisting their maximum parlicipation/involvement in sustainability programme activities. Introduction of yearly a'ivard for the best performing LGA to serve as rnotivation and encourage competition among the various LGAs. HOW THE CHALL GES WERE MET especially with regards to incentives to CDDs 4t WllO/APOC. 26 September 2003